Fludarabine, cytarabine, granulocyte colony-stimulating factor and idarubicin for relapsed childhood acute myeloid leukemia

Hideki Nakayama, Daisuke Tomizawa, Shiro Tanaka, Shotaro Iwamoto, Akira Shimada, Akiko M. Saito, Yuka Yamashita, Hiroshi Moritake, Kiminori Terui, Takashi Taga, Hidemasa Matsuo, Yoshiyuki Kosaka, Katsuyoshi Koh, Hajime Hosoi, Hidemitsu Kurosawa, Keiichi Isoyama, Keizo Horibe, Shuki Mizutani, Souichi Adachi

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Abstract

Background: The combination of fludarabine (Flu), high-dose cytarabine (Ara-C) and granulocyte colony-stimulating factor (G-CSF; FLAG), with anthracyclines has become standard chemotherapy for refractory acute myeloid leukemia (AML) in European children and adults. To clarify the efficacy and the safety of FLAG-idarubicin (IDA) for children prospectively, we planned a multicenter phase II study (AML-R11) by the Japanese Pediatric Leukemia/Lymphoma Study Group. Methods: Patients with AML aged between 2 and 20 years old, who had the first bone marrow (BM) relapse or induction failure, were enrolled. The FLAG-IDA regimen consisted of Flu 30 mg/m2 for 5 days, Ara-C 2 g/m2 for 5 days, G-CSF (lenograstim) 5 μg/kg for 6 days and IDA 10 mg/m2 for 3 days. The primary endpoint was remission rate after therapy. Results: Due to drug supply issues, the trial was suspended after the inclusion of seven eligible patients. There were six cases of early relapse within 1 year of the first remission. All seven patients completed the therapy and no early death was observed. Hematological toxicity was common, and one patient developed grade 4 non-hematological toxicity of bacterial meningitis. Although only one patient with late relapse achieved complete remission, minimal residual disease was positive on both flow cytometry and Wilms’ tumor 1 mRNA. Two patients were alive in remission following hematopoietic stem cell transplantation, whereas the other five patients died of either the disease or treatment-related causes. Conclusion: FLAG-IDA might be tolerable for children with refractory AML although the efficacy should be further investigated.

Original languageEnglish
Pages (from-to)1046-1052
Number of pages7
JournalPediatrics International
Volume59
Issue number10
DOIs
Publication statusPublished - Oct 1 2017

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Idarubicin
Cytarabine
Granulocyte Colony-Stimulating Factor
Acute Myeloid Leukemia
Recurrence
Bacterial Meningitides
Wilms Tumor
Anthracyclines
Hematopoietic Stem Cell Transplantation
Residual Neoplasm
fludarabine
Lymphoma
Flow Cytometry
Leukemia
Therapeutics
Bone Marrow
Pediatrics
Safety
Drug Therapy
Messenger RNA

Keywords

  • acute myeloid leukemia
  • children
  • FLAG-IDA
  • minimal residual disease
  • relapse

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Fludarabine, cytarabine, granulocyte colony-stimulating factor and idarubicin for relapsed childhood acute myeloid leukemia. / Nakayama, Hideki; Tomizawa, Daisuke; Tanaka, Shiro; Iwamoto, Shotaro; Shimada, Akira; Saito, Akiko M.; Yamashita, Yuka; Moritake, Hiroshi; Terui, Kiminori; Taga, Takashi; Matsuo, Hidemasa; Kosaka, Yoshiyuki; Koh, Katsuyoshi; Hosoi, Hajime; Kurosawa, Hidemitsu; Isoyama, Keiichi; Horibe, Keizo; Mizutani, Shuki; Adachi, Souichi.

In: Pediatrics International, Vol. 59, No. 10, 01.10.2017, p. 1046-1052.

Research output: Contribution to journalArticle

Nakayama, H, Tomizawa, D, Tanaka, S, Iwamoto, S, Shimada, A, Saito, AM, Yamashita, Y, Moritake, H, Terui, K, Taga, T, Matsuo, H, Kosaka, Y, Koh, K, Hosoi, H, Kurosawa, H, Isoyama, K, Horibe, K, Mizutani, S & Adachi, S 2017, 'Fludarabine, cytarabine, granulocyte colony-stimulating factor and idarubicin for relapsed childhood acute myeloid leukemia', Pediatrics International, vol. 59, no. 10, pp. 1046-1052. https://doi.org/10.1111/ped.13378
Nakayama, Hideki ; Tomizawa, Daisuke ; Tanaka, Shiro ; Iwamoto, Shotaro ; Shimada, Akira ; Saito, Akiko M. ; Yamashita, Yuka ; Moritake, Hiroshi ; Terui, Kiminori ; Taga, Takashi ; Matsuo, Hidemasa ; Kosaka, Yoshiyuki ; Koh, Katsuyoshi ; Hosoi, Hajime ; Kurosawa, Hidemitsu ; Isoyama, Keiichi ; Horibe, Keizo ; Mizutani, Shuki ; Adachi, Souichi. / Fludarabine, cytarabine, granulocyte colony-stimulating factor and idarubicin for relapsed childhood acute myeloid leukemia. In: Pediatrics International. 2017 ; Vol. 59, No. 10. pp. 1046-1052.
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T1 - Fludarabine, cytarabine, granulocyte colony-stimulating factor and idarubicin for relapsed childhood acute myeloid leukemia

AU - Nakayama, Hideki

AU - Tomizawa, Daisuke

AU - Tanaka, Shiro

AU - Iwamoto, Shotaro

AU - Shimada, Akira

AU - Saito, Akiko M.

AU - Yamashita, Yuka

AU - Moritake, Hiroshi

AU - Terui, Kiminori

AU - Taga, Takashi

AU - Matsuo, Hidemasa

AU - Kosaka, Yoshiyuki

AU - Koh, Katsuyoshi

AU - Hosoi, Hajime

AU - Kurosawa, Hidemitsu

AU - Isoyama, Keiichi

AU - Horibe, Keizo

AU - Mizutani, Shuki

AU - Adachi, Souichi

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Background: The combination of fludarabine (Flu), high-dose cytarabine (Ara-C) and granulocyte colony-stimulating factor (G-CSF; FLAG), with anthracyclines has become standard chemotherapy for refractory acute myeloid leukemia (AML) in European children and adults. To clarify the efficacy and the safety of FLAG-idarubicin (IDA) for children prospectively, we planned a multicenter phase II study (AML-R11) by the Japanese Pediatric Leukemia/Lymphoma Study Group. Methods: Patients with AML aged between 2 and 20 years old, who had the first bone marrow (BM) relapse or induction failure, were enrolled. The FLAG-IDA regimen consisted of Flu 30 mg/m2 for 5 days, Ara-C 2 g/m2 for 5 days, G-CSF (lenograstim) 5 μg/kg for 6 days and IDA 10 mg/m2 for 3 days. The primary endpoint was remission rate after therapy. Results: Due to drug supply issues, the trial was suspended after the inclusion of seven eligible patients. There were six cases of early relapse within 1 year of the first remission. All seven patients completed the therapy and no early death was observed. Hematological toxicity was common, and one patient developed grade 4 non-hematological toxicity of bacterial meningitis. Although only one patient with late relapse achieved complete remission, minimal residual disease was positive on both flow cytometry and Wilms’ tumor 1 mRNA. Two patients were alive in remission following hematopoietic stem cell transplantation, whereas the other five patients died of either the disease or treatment-related causes. Conclusion: FLAG-IDA might be tolerable for children with refractory AML although the efficacy should be further investigated.

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